Defense Health Care: Actions Needed to Assess Civilian Partnerships’ Contributions to Readiness
Fast Facts
The U.S. military must be ready to provide lifesaving medical care on the battlefield. The Department of Defense calls this "clinical readiness." DOD partners with civilian medical facilities like trauma centers to help its medical personnel maintain clinical readiness skills off the battlefield.
The partnerships enable medical personnel to perform patient care work at the facilities. But DOD doesn't collect enough data on the work performed, making it hard to tell if personnel are getting the experience they need. DOD also doesn't know how many partnerships it has and hasn't identified ways to save costs.
Our recommendations address this.
Close up of a person’s torso and arms wearing camouflage holding a stethoscope. An American flag is in the background.
Highlights
What GAO Found
The Department of Defense’s (DOD) decisions to partner with civilian medical facilities to train military medical personnel for the battlefield are influenced by various factors that can support or hinder the use of partnerships, according to officials. One type of partnership that DOD can establish through an external resource sharing agreement allows active-duty providers to provide medical care to beneficiaries in civilian medical facilities within DOD’s network. Using these partnerships can reduce costs by avoiding certain professional fees and by keeping patient care within the network. However, DOD has not fully explored the benefits of increasing the use of these partnerships. Developing strategies to identify opportunities for using such agreements could ultimately help reduce costs, increase clinical readiness, and improve access to care.
Factors Influencing DOD’s Decision to Use Civilian Medical Partnerships
The Defense Health Agency (DHA)—the combat support agency responsible for providing the necessary clinical workload to meet the military departments’ medical readiness requirements—does not know the total number of partnerships department-wide. DHA has taken some steps to inventory partnerships with civilian entities consistent with DOD policy to do so. However, these steps have been ad hoc and have not resulted in a complete or updated inventory. Without a standardized process for collecting information on partnerships for such an inventory, DHA has limited visibility of partnerships with civilian entities that can be used to provide additional readiness opportunities for its military medical personnel.
DOD also has not fully assessed the contributions of partnerships to clinical readiness. The military departments have implemented some efforts to collect clinical activity data to assess the clinical readiness opportunities provided by partnerships they established. However, each military department maintains partnerships that have not been fully assessed. Similarly, DHA does not have complete data needed to fully assess partnerships department-wide because it has not issued guidance for collecting complete clinical activity data. Without such guidance, DOD risks having less information to evaluate partnership performance and trading off opportunities to send personnel to a partnership for skills sustainment in lieu of them working in a DOD medical facility to provide beneficiary care.
Why GAO Did This Study
DOD has had a longstanding concern that some military medical personnel may not be prepared to provide lifesaving medical care on the battlefield. To address this issue, DOD has, among other things, established partnerships with civilian trauma centers and other medical facilities to provide opportunities for training its military medical personnel.
Committee reports accompanying bills for the National Defense Authorization Act for Fiscal Year 2024 include provisions for GAO to assess DOD’s partnerships. This report examines (1) the factors influencing DOD’s decisions to use a partnership and efforts to reduce health care costs; (2) DHA’s inventory of partnerships; and (3) DOD’s assessment of partnership contributions to the readiness of its medical personnel.
GAO reviewed DOD guidance and documentation and analyzed timecard and readiness data, where available, from fiscal year 2020 through fiscal year 2024. GAO also interviewed DOD officials, including officials from seven medical facilities selected based on military department affiliation and size, as well as officials from civilian partners.
Recommendations
GAO is making nine recommendations, including that DOD develop strategies to identify opportunities for reducing costs while increasing readiness through partnerships established by external resource sharing agreements; develop processes to inventory partnerships; and fully assess the readiness contributions of its partnerships. DOD concurred with seven recommendations and partially concurred with two recommendations. GAO believes all recommendations are sound and should be fully addressed.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Secretary of Defense should ensure that the Director of DHA develops and implements department-wide strategies to identify opportunities for reducing health care costs while increasing readiness through use of partnerships established by external resource sharing agreements. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should ensure that the Director of DHA, in coordination with the Secretaries of the military departments, develop a standardized process for routinely and accurately inventorying its partnerships, including identifying types of partnerships that should be included in its inventory. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Army | The Secretary of the Army should establish a standardized process for routinely and accurately inventorying its partnerships. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Navy | The Secretary of the Navy should establish a standardized process for routinely and accurately inventorying its partnerships. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Air Force | The Secretary of the Air Force should establish a standardized process for routinely and accurately inventorying its partnerships. (Recommendation 5) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Army | The Secretary of the Army should establish processes to fully assess the readiness contributions of its military-civilian partnerships. (Recommendation 6) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Navy | The Secretary of the Navy should establish processes to fully assess the readiness contributions of its military-civilian partnerships. (Recommendation 7) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Air Force | The Secretary of the Air Force should establish processes to fully assess the readiness contributions of its military-civilian partnerships. (Recommendation 8) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should ensure that the Director of DHA issues guidance for collecting complete clinical activity data from military-civilian partnerships for all personnel in specialties with clinical readiness metrics. (Recommendation 9) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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